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They enrolled in medical school to practice rural medicine. What happened?
SALINA, KAN. – The University of Kansas School of Medicine–Salina opened in 2011 – a one-building campus in the heart of wheat country dedicated to producing the rural doctors that the country needs.
Now, 8 years later, the school’s first graduates are settling into their chosen practices – and locales. And those choices are cause for both hope and despair.
Of the eight graduates, just three chose to go where the shortages are most evident. Two went to small cities with populations of fewer than 50,000. And three chose the big cities of Topeka (estimated 2018 population: 125,904) and Wichita (389,255) instead.
But the mission is critical: About two-thirds of the primary care health professional shortage areas designated by the federal Health Resources and Services Administration in June were in rural or partially rural areas. And it’s only getting worse.
As more baby boomer doctors in rural areas reach retirement age, not nearly enough physicians are willing to take their place. By 2030, the New England Journal of Medicine predicts, nearly a quarter fewer rural physicians will be practicing medicine than today. Over half of rural doctors were at least 50 years old in 2017.
So Salina’s creation of a few rural physicians a year is a start, and, surprisingly, one of the country’s most promising.
Only 40 out of the nation’s more than 180 medical schools offer a rural track. The Association of American Medical Colleges ranked KU School of Medicine, which includes Salina, Wichita and Kansas City campuses, in the 96th percentile last year for producing doctors working in rural settings 10-15 years after graduation.
“The addition of one physician is huge,” said William Cathcart-Rake, MD, the founding dean of the Salina campus. “One physician choosing to come may be the difference of communities surviving or dissolving.”
The draw of rural life
By placing the new campus in Salina (population: 46,716), surrounded by small towns for at least 50 miles in every direction, the university hoped to attract and foster students who had – and would deepen – a bond to rural communities.
And, for some, it worked out pretty much as planned.
One of the school’s first graduates, Sara Ritterling Patry, MD, lives in Hutchinson (population: 40,623). Less than an hour from Wichita, it isn’t the most rural community, but it’s small enough that she still runs into her patients at Dillons, the local grocery store.
“Just being in a smaller community like this feels like to me that I can actually get to know my patients and spend a little extra time with them,” she said.
After all, part of the allure of a rural practice is providing care womb to tomb. The doctor learns how to deliver the town’s babies, while serving as the county coroner and the public health expert all at once, said Robert Moser, MD, the head of the University of Kansas School of Medicine–Salina and former head of the state health department.
He would know – he worked for 22 years in Tribune, Kan. (population: 742).
For another of the original Salina eight, Tyson Wisinger, MD, that calling brought him back to his hometown of Phillipsburg (population: 2,486) after his residency. His kids will go to his old high school, where his graduating class was all of 13 people, and he’ll take care of their baseball teammates. Plus, they’ll grow up living minutes away from generations of extended family.
“I can’t have imagined a situation that could have been more rewarding,” Dr. Wisinger said.
The rural challenge
But the road to rural family medicine also includes a thing called “windshield time” – the amount of time needed to travel between clinics or head to the closest Walmart.
Then there’s figuring out just how far their patients will need to drive to get to the nearest hospital – which for Daniel Linville, MD, and Jill Corpstein Linville, MD, is a solid 4 hours for more advanced care from their new practice in Lakin, Kan. (population: 2,195).
Their outpost in southwestern Kansas can feel a little bit like a fishbowl. “We do life with some of our patients,” Dr. Corpstein Linville said.
Already, the Linvilles have delivered babies and handled a variety of ailments there.
The pair met and married during their 4 years in Salina – they jokingly call it a “full-service med school.” They completed a family medicine residency in Muncie, Ind. Then they were recruited by a rural practice that helped them avoid what Dr. Moser calls the most dreaded words in rural medicine: “solo practice.”
New doctors don’t want to practice alone, especially as they develop their sea legs, because of the strains of constantly being on call and having singular responsibility for a town. Telemedicine, where doctors can easily consult with other physicians around the country via Web video or phone, is helping, as are physician assistants.
Diverging from the path
Claire Hinrichsen Groskurth, MD, another member of the first graduating class, always intended to return to a small town similar to where she grew up.
“The first thing that threw me off was I fell in love with surgery and ob.gyn.,” she said. “Then the second thing that threw me off was marrying another doctor,” whose life goals headed in a different direction.
She’d been a member of the Scholars in Rural Health program at Kansas University that seeks out rural college students who are interested in medicine. She also had committed to the Kansas Medical Student Loan program, which promises to forgive physicians’ tuition and gives a monthly stipend if they agree to work in counties that need physicians, or in other critical capacities.
But when she realized she might specialize, she decided to take out federal loans for her final years. She had to pay back the first year of the special loan with 15% interest.
Plus, her now-husband, who went to Kansas University’s Wichita campus, needed to be in a large enough city to accommodate further training to become a surgeon. So Dr. Hinrichsen Groskurth delivers babies as she thought she would – but in Wichita.
The spousal coin can flip both ways: Dr. Ritterling Patry needed to find a place that worked for her husband’s farming of corn, sorghum, soybeans and wheat. So the smaller city of Hutchinson it was.
Flaws in the pipeline
Most medical school students come from urban areas and are destined to stay there, said Alan Morgan, the head of the National Rural Health Association. Producing doctors for the vast swaths of rural America needs to be more of a priority at every step in the education pipeline, experts said.
Many academic centers sell students on the party line that they’ll be overworked, underappreciated and underpaid, according to Mark Deutchman, MD, director of the University of Colorado School of Medicine’s rural program. “They take people who are interested in primary care or rural and beat it out of them throughout their training,” he said.
And that kind of rhetoric often influences the opinion of their medical school peers, which those in rural health might resent.
“Small does not mean stupid,” Dr. Moser said.
Medical students everywhere should be exposed to rural options, according to Randall Longenecker, MD, who runs Ohio University Heritage College of Osteopathic Medicine’s rural programs in Athens.
“If a medical student never ever goes to a rural place, they never find out,” he said. “That’s why students need to meet rural doctors who love what they do.”
The federal government recently allocated $20 million in grants to help create 27 rural residency programs – institutions where newly minted doctors go for practical training before they can be fully licensed. That’s a big jump from the 92 programs now active.
For Dr. Corpstein Linville, the pipeline also needs to start at more schools like Salina that are promoting rural medicine from day one.
“So when you hear rural medicine, you know that it’s a thing and don’t kind of cringe,” she said. “You don’t think it’s someone taking care of a cow.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
SALINA, KAN. – The University of Kansas School of Medicine–Salina opened in 2011 – a one-building campus in the heart of wheat country dedicated to producing the rural doctors that the country needs.
Now, 8 years later, the school’s first graduates are settling into their chosen practices – and locales. And those choices are cause for both hope and despair.
Of the eight graduates, just three chose to go where the shortages are most evident. Two went to small cities with populations of fewer than 50,000. And three chose the big cities of Topeka (estimated 2018 population: 125,904) and Wichita (389,255) instead.
But the mission is critical: About two-thirds of the primary care health professional shortage areas designated by the federal Health Resources and Services Administration in June were in rural or partially rural areas. And it’s only getting worse.
As more baby boomer doctors in rural areas reach retirement age, not nearly enough physicians are willing to take their place. By 2030, the New England Journal of Medicine predicts, nearly a quarter fewer rural physicians will be practicing medicine than today. Over half of rural doctors were at least 50 years old in 2017.
So Salina’s creation of a few rural physicians a year is a start, and, surprisingly, one of the country’s most promising.
Only 40 out of the nation’s more than 180 medical schools offer a rural track. The Association of American Medical Colleges ranked KU School of Medicine, which includes Salina, Wichita and Kansas City campuses, in the 96th percentile last year for producing doctors working in rural settings 10-15 years after graduation.
“The addition of one physician is huge,” said William Cathcart-Rake, MD, the founding dean of the Salina campus. “One physician choosing to come may be the difference of communities surviving or dissolving.”
The draw of rural life
By placing the new campus in Salina (population: 46,716), surrounded by small towns for at least 50 miles in every direction, the university hoped to attract and foster students who had – and would deepen – a bond to rural communities.
And, for some, it worked out pretty much as planned.
One of the school’s first graduates, Sara Ritterling Patry, MD, lives in Hutchinson (population: 40,623). Less than an hour from Wichita, it isn’t the most rural community, but it’s small enough that she still runs into her patients at Dillons, the local grocery store.
“Just being in a smaller community like this feels like to me that I can actually get to know my patients and spend a little extra time with them,” she said.
After all, part of the allure of a rural practice is providing care womb to tomb. The doctor learns how to deliver the town’s babies, while serving as the county coroner and the public health expert all at once, said Robert Moser, MD, the head of the University of Kansas School of Medicine–Salina and former head of the state health department.
He would know – he worked for 22 years in Tribune, Kan. (population: 742).
For another of the original Salina eight, Tyson Wisinger, MD, that calling brought him back to his hometown of Phillipsburg (population: 2,486) after his residency. His kids will go to his old high school, where his graduating class was all of 13 people, and he’ll take care of their baseball teammates. Plus, they’ll grow up living minutes away from generations of extended family.
“I can’t have imagined a situation that could have been more rewarding,” Dr. Wisinger said.
The rural challenge
But the road to rural family medicine also includes a thing called “windshield time” – the amount of time needed to travel between clinics or head to the closest Walmart.
Then there’s figuring out just how far their patients will need to drive to get to the nearest hospital – which for Daniel Linville, MD, and Jill Corpstein Linville, MD, is a solid 4 hours for more advanced care from their new practice in Lakin, Kan. (population: 2,195).
Their outpost in southwestern Kansas can feel a little bit like a fishbowl. “We do life with some of our patients,” Dr. Corpstein Linville said.
Already, the Linvilles have delivered babies and handled a variety of ailments there.
The pair met and married during their 4 years in Salina – they jokingly call it a “full-service med school.” They completed a family medicine residency in Muncie, Ind. Then they were recruited by a rural practice that helped them avoid what Dr. Moser calls the most dreaded words in rural medicine: “solo practice.”
New doctors don’t want to practice alone, especially as they develop their sea legs, because of the strains of constantly being on call and having singular responsibility for a town. Telemedicine, where doctors can easily consult with other physicians around the country via Web video or phone, is helping, as are physician assistants.
Diverging from the path
Claire Hinrichsen Groskurth, MD, another member of the first graduating class, always intended to return to a small town similar to where she grew up.
“The first thing that threw me off was I fell in love with surgery and ob.gyn.,” she said. “Then the second thing that threw me off was marrying another doctor,” whose life goals headed in a different direction.
She’d been a member of the Scholars in Rural Health program at Kansas University that seeks out rural college students who are interested in medicine. She also had committed to the Kansas Medical Student Loan program, which promises to forgive physicians’ tuition and gives a monthly stipend if they agree to work in counties that need physicians, or in other critical capacities.
But when she realized she might specialize, she decided to take out federal loans for her final years. She had to pay back the first year of the special loan with 15% interest.
Plus, her now-husband, who went to Kansas University’s Wichita campus, needed to be in a large enough city to accommodate further training to become a surgeon. So Dr. Hinrichsen Groskurth delivers babies as she thought she would – but in Wichita.
The spousal coin can flip both ways: Dr. Ritterling Patry needed to find a place that worked for her husband’s farming of corn, sorghum, soybeans and wheat. So the smaller city of Hutchinson it was.
Flaws in the pipeline
Most medical school students come from urban areas and are destined to stay there, said Alan Morgan, the head of the National Rural Health Association. Producing doctors for the vast swaths of rural America needs to be more of a priority at every step in the education pipeline, experts said.
Many academic centers sell students on the party line that they’ll be overworked, underappreciated and underpaid, according to Mark Deutchman, MD, director of the University of Colorado School of Medicine’s rural program. “They take people who are interested in primary care or rural and beat it out of them throughout their training,” he said.
And that kind of rhetoric often influences the opinion of their medical school peers, which those in rural health might resent.
“Small does not mean stupid,” Dr. Moser said.
Medical students everywhere should be exposed to rural options, according to Randall Longenecker, MD, who runs Ohio University Heritage College of Osteopathic Medicine’s rural programs in Athens.
“If a medical student never ever goes to a rural place, they never find out,” he said. “That’s why students need to meet rural doctors who love what they do.”
The federal government recently allocated $20 million in grants to help create 27 rural residency programs – institutions where newly minted doctors go for practical training before they can be fully licensed. That’s a big jump from the 92 programs now active.
For Dr. Corpstein Linville, the pipeline also needs to start at more schools like Salina that are promoting rural medicine from day one.
“So when you hear rural medicine, you know that it’s a thing and don’t kind of cringe,” she said. “You don’t think it’s someone taking care of a cow.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
SALINA, KAN. – The University of Kansas School of Medicine–Salina opened in 2011 – a one-building campus in the heart of wheat country dedicated to producing the rural doctors that the country needs.
Now, 8 years later, the school’s first graduates are settling into their chosen practices – and locales. And those choices are cause for both hope and despair.
Of the eight graduates, just three chose to go where the shortages are most evident. Two went to small cities with populations of fewer than 50,000. And three chose the big cities of Topeka (estimated 2018 population: 125,904) and Wichita (389,255) instead.
But the mission is critical: About two-thirds of the primary care health professional shortage areas designated by the federal Health Resources and Services Administration in June were in rural or partially rural areas. And it’s only getting worse.
As more baby boomer doctors in rural areas reach retirement age, not nearly enough physicians are willing to take their place. By 2030, the New England Journal of Medicine predicts, nearly a quarter fewer rural physicians will be practicing medicine than today. Over half of rural doctors were at least 50 years old in 2017.
So Salina’s creation of a few rural physicians a year is a start, and, surprisingly, one of the country’s most promising.
Only 40 out of the nation’s more than 180 medical schools offer a rural track. The Association of American Medical Colleges ranked KU School of Medicine, which includes Salina, Wichita and Kansas City campuses, in the 96th percentile last year for producing doctors working in rural settings 10-15 years after graduation.
“The addition of one physician is huge,” said William Cathcart-Rake, MD, the founding dean of the Salina campus. “One physician choosing to come may be the difference of communities surviving or dissolving.”
The draw of rural life
By placing the new campus in Salina (population: 46,716), surrounded by small towns for at least 50 miles in every direction, the university hoped to attract and foster students who had – and would deepen – a bond to rural communities.
And, for some, it worked out pretty much as planned.
One of the school’s first graduates, Sara Ritterling Patry, MD, lives in Hutchinson (population: 40,623). Less than an hour from Wichita, it isn’t the most rural community, but it’s small enough that she still runs into her patients at Dillons, the local grocery store.
“Just being in a smaller community like this feels like to me that I can actually get to know my patients and spend a little extra time with them,” she said.
After all, part of the allure of a rural practice is providing care womb to tomb. The doctor learns how to deliver the town’s babies, while serving as the county coroner and the public health expert all at once, said Robert Moser, MD, the head of the University of Kansas School of Medicine–Salina and former head of the state health department.
He would know – he worked for 22 years in Tribune, Kan. (population: 742).
For another of the original Salina eight, Tyson Wisinger, MD, that calling brought him back to his hometown of Phillipsburg (population: 2,486) after his residency. His kids will go to his old high school, where his graduating class was all of 13 people, and he’ll take care of their baseball teammates. Plus, they’ll grow up living minutes away from generations of extended family.
“I can’t have imagined a situation that could have been more rewarding,” Dr. Wisinger said.
The rural challenge
But the road to rural family medicine also includes a thing called “windshield time” – the amount of time needed to travel between clinics or head to the closest Walmart.
Then there’s figuring out just how far their patients will need to drive to get to the nearest hospital – which for Daniel Linville, MD, and Jill Corpstein Linville, MD, is a solid 4 hours for more advanced care from their new practice in Lakin, Kan. (population: 2,195).
Their outpost in southwestern Kansas can feel a little bit like a fishbowl. “We do life with some of our patients,” Dr. Corpstein Linville said.
Already, the Linvilles have delivered babies and handled a variety of ailments there.
The pair met and married during their 4 years in Salina – they jokingly call it a “full-service med school.” They completed a family medicine residency in Muncie, Ind. Then they were recruited by a rural practice that helped them avoid what Dr. Moser calls the most dreaded words in rural medicine: “solo practice.”
New doctors don’t want to practice alone, especially as they develop their sea legs, because of the strains of constantly being on call and having singular responsibility for a town. Telemedicine, where doctors can easily consult with other physicians around the country via Web video or phone, is helping, as are physician assistants.
Diverging from the path
Claire Hinrichsen Groskurth, MD, another member of the first graduating class, always intended to return to a small town similar to where she grew up.
“The first thing that threw me off was I fell in love with surgery and ob.gyn.,” she said. “Then the second thing that threw me off was marrying another doctor,” whose life goals headed in a different direction.
She’d been a member of the Scholars in Rural Health program at Kansas University that seeks out rural college students who are interested in medicine. She also had committed to the Kansas Medical Student Loan program, which promises to forgive physicians’ tuition and gives a monthly stipend if they agree to work in counties that need physicians, or in other critical capacities.
But when she realized she might specialize, she decided to take out federal loans for her final years. She had to pay back the first year of the special loan with 15% interest.
Plus, her now-husband, who went to Kansas University’s Wichita campus, needed to be in a large enough city to accommodate further training to become a surgeon. So Dr. Hinrichsen Groskurth delivers babies as she thought she would – but in Wichita.
The spousal coin can flip both ways: Dr. Ritterling Patry needed to find a place that worked for her husband’s farming of corn, sorghum, soybeans and wheat. So the smaller city of Hutchinson it was.
Flaws in the pipeline
Most medical school students come from urban areas and are destined to stay there, said Alan Morgan, the head of the National Rural Health Association. Producing doctors for the vast swaths of rural America needs to be more of a priority at every step in the education pipeline, experts said.
Many academic centers sell students on the party line that they’ll be overworked, underappreciated and underpaid, according to Mark Deutchman, MD, director of the University of Colorado School of Medicine’s rural program. “They take people who are interested in primary care or rural and beat it out of them throughout their training,” he said.
And that kind of rhetoric often influences the opinion of their medical school peers, which those in rural health might resent.
“Small does not mean stupid,” Dr. Moser said.
Medical students everywhere should be exposed to rural options, according to Randall Longenecker, MD, who runs Ohio University Heritage College of Osteopathic Medicine’s rural programs in Athens.
“If a medical student never ever goes to a rural place, they never find out,” he said. “That’s why students need to meet rural doctors who love what they do.”
The federal government recently allocated $20 million in grants to help create 27 rural residency programs – institutions where newly minted doctors go for practical training before they can be fully licensed. That’s a big jump from the 92 programs now active.
For Dr. Corpstein Linville, the pipeline also needs to start at more schools like Salina that are promoting rural medicine from day one.
“So when you hear rural medicine, you know that it’s a thing and don’t kind of cringe,” she said. “You don’t think it’s someone taking care of a cow.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
What closing Missouri’s last abortion clinic will mean for neighboring states
ST. LOUIS – As the last abortion clinic in Missouri warned that it will have to stop providing the procedure as soon as May 31, abortion providers in surrounding states said they are anticipating an uptick of even more Missouri patients.
At Hope Clinic in Granite City, Ill., just 10 minutes from downtown St. Louis, Deputy Director Alison Dreith said on May 28 that her clinic was preparing for more patients as news about Missouri spread.
“We’re really scrambling today about the need for increased staff and how fast can we hire and train,” Dreith said.
And at a Trust Women clinic in Wichita, Kan., that already has to fly in doctors, the staff didn’t know what it would mean for their overloaded patient schedule.
“God forbid we see that people can’t get services in Missouri,” said Julie Burkhart, Trust Women founder and CEO. “What is that going to mean on our limited physician days?”
If St. Louis’ Planned Parenthood clinic is unable to offer abortions, the group said, Missouri would be the only state in the country to not have an operating abortion clinic. Five other states – Kentucky, Mississippi, North Dakota, South Dakota and West Virginia – reportedly have only one abortion clinic. And 90% of U.S. counties didn’t have an abortion clinic as of 2014, according to the Guttmacher Institute, a reproductive rights research and advocacy group.
For some, this echoes back to the days before abortion was legalized nationwide in 1973 with the Supreme Court’s Roe v. Wade decision, when patients who could afford to travel would go to more liberal states like California or New York where abortion was legal.
But providers in Kansas and Illinois say this influx from Missouri isn’t new. About half of their clients already come from the Show Me State. To the south, in neighboring Arkansas, where a 72-hour waiting period will go into effect in July, the vast majority of its patients still live within the state.
Over the past 10 years, four Missouri abortion clinics have closed because of increased regulations, including a mandatory 72-hour waiting period after receiving counseling on abortion, thus requiring two trips to a facility; requirements that physicians have hospital admitting privileges within 15 minutes of their clinics; and a rule requiring two-parent notification for minors and one-parent notarized consent. All those limits left one clinic in downtown St. Louis to serve the whole state.
Now Planned Parenthood, which operates that final abortion clinic, said on May 28 that it will be forced to end its abortion services altogether by May 31 if the state suspends its license. The closure is not related to new anti-abortion laws that Missouri Gov. Mike Parson, a Republican, signed on May 24 to ban most abortions after 8 weeks of pregnancy. The new laws don’t take effect until August.
Already the number of patients in Missouri seeking an abortion at the clinic from April 2018 until this April had dropped by 50% compared with the same period the previous year. Planned Parenthood spokesman Jesse Lawder attributes two-thirds of the decrease to the clinic’s refusal to do pelvic exams for abortions performed through medication – recently required by the state – thus forcing all such abortions to be performed out of state.
For Dreith, while she expects the Missouri numbers to continue to grow at her Illinois clinic across the Mississippi River, it’s not the only state sending patients her way.
“Patients were literally coming to us from the last remaining clinics in Kentucky ... so that they wouldn’t get past 24 weeks,” Dreith said. “We don’t want these patients in surrounding states traveling [to] New York [or] California like they once had to.”
That’s how it was prior to the Roe v. Wade ruling, according to Mary Ziegler, a professor at Florida State University College of Law who is writing her third book on the history of the legal battle around abortion access. She anticipates the pattern of privilege will repeat itself.
“You would still expect women with resources to be able to travel as far as they needed,” she said. “And you would expect women without resources to not be able to travel. ... The more the court retreats from protecting abortion rights, the more stark those differences will become.”
For Dreith, the historical comparison to the pre-Roe era rings true, albeit with improved medical practices.
There are safer, easier, and more effective ways to perform abortions now than the “horror stories that we saw pre-Roe,” said Dreith. “But I think the travel will be one of the huge throwbacks and the scariest part will be the criminalization.”
States such as Missouri could feel pressure to start arresting women who perform their own abortions with pills at home or travel out of state, Ziegler said. But, she said, “punishing women isn’t something that’s thought to be very popular.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
ST. LOUIS – As the last abortion clinic in Missouri warned that it will have to stop providing the procedure as soon as May 31, abortion providers in surrounding states said they are anticipating an uptick of even more Missouri patients.
At Hope Clinic in Granite City, Ill., just 10 minutes from downtown St. Louis, Deputy Director Alison Dreith said on May 28 that her clinic was preparing for more patients as news about Missouri spread.
“We’re really scrambling today about the need for increased staff and how fast can we hire and train,” Dreith said.
And at a Trust Women clinic in Wichita, Kan., that already has to fly in doctors, the staff didn’t know what it would mean for their overloaded patient schedule.
“God forbid we see that people can’t get services in Missouri,” said Julie Burkhart, Trust Women founder and CEO. “What is that going to mean on our limited physician days?”
If St. Louis’ Planned Parenthood clinic is unable to offer abortions, the group said, Missouri would be the only state in the country to not have an operating abortion clinic. Five other states – Kentucky, Mississippi, North Dakota, South Dakota and West Virginia – reportedly have only one abortion clinic. And 90% of U.S. counties didn’t have an abortion clinic as of 2014, according to the Guttmacher Institute, a reproductive rights research and advocacy group.
For some, this echoes back to the days before abortion was legalized nationwide in 1973 with the Supreme Court’s Roe v. Wade decision, when patients who could afford to travel would go to more liberal states like California or New York where abortion was legal.
But providers in Kansas and Illinois say this influx from Missouri isn’t new. About half of their clients already come from the Show Me State. To the south, in neighboring Arkansas, where a 72-hour waiting period will go into effect in July, the vast majority of its patients still live within the state.
Over the past 10 years, four Missouri abortion clinics have closed because of increased regulations, including a mandatory 72-hour waiting period after receiving counseling on abortion, thus requiring two trips to a facility; requirements that physicians have hospital admitting privileges within 15 minutes of their clinics; and a rule requiring two-parent notification for minors and one-parent notarized consent. All those limits left one clinic in downtown St. Louis to serve the whole state.
Now Planned Parenthood, which operates that final abortion clinic, said on May 28 that it will be forced to end its abortion services altogether by May 31 if the state suspends its license. The closure is not related to new anti-abortion laws that Missouri Gov. Mike Parson, a Republican, signed on May 24 to ban most abortions after 8 weeks of pregnancy. The new laws don’t take effect until August.
Already the number of patients in Missouri seeking an abortion at the clinic from April 2018 until this April had dropped by 50% compared with the same period the previous year. Planned Parenthood spokesman Jesse Lawder attributes two-thirds of the decrease to the clinic’s refusal to do pelvic exams for abortions performed through medication – recently required by the state – thus forcing all such abortions to be performed out of state.
For Dreith, while she expects the Missouri numbers to continue to grow at her Illinois clinic across the Mississippi River, it’s not the only state sending patients her way.
“Patients were literally coming to us from the last remaining clinics in Kentucky ... so that they wouldn’t get past 24 weeks,” Dreith said. “We don’t want these patients in surrounding states traveling [to] New York [or] California like they once had to.”
That’s how it was prior to the Roe v. Wade ruling, according to Mary Ziegler, a professor at Florida State University College of Law who is writing her third book on the history of the legal battle around abortion access. She anticipates the pattern of privilege will repeat itself.
“You would still expect women with resources to be able to travel as far as they needed,” she said. “And you would expect women without resources to not be able to travel. ... The more the court retreats from protecting abortion rights, the more stark those differences will become.”
For Dreith, the historical comparison to the pre-Roe era rings true, albeit with improved medical practices.
There are safer, easier, and more effective ways to perform abortions now than the “horror stories that we saw pre-Roe,” said Dreith. “But I think the travel will be one of the huge throwbacks and the scariest part will be the criminalization.”
States such as Missouri could feel pressure to start arresting women who perform their own abortions with pills at home or travel out of state, Ziegler said. But, she said, “punishing women isn’t something that’s thought to be very popular.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
ST. LOUIS – As the last abortion clinic in Missouri warned that it will have to stop providing the procedure as soon as May 31, abortion providers in surrounding states said they are anticipating an uptick of even more Missouri patients.
At Hope Clinic in Granite City, Ill., just 10 minutes from downtown St. Louis, Deputy Director Alison Dreith said on May 28 that her clinic was preparing for more patients as news about Missouri spread.
“We’re really scrambling today about the need for increased staff and how fast can we hire and train,” Dreith said.
And at a Trust Women clinic in Wichita, Kan., that already has to fly in doctors, the staff didn’t know what it would mean for their overloaded patient schedule.
“God forbid we see that people can’t get services in Missouri,” said Julie Burkhart, Trust Women founder and CEO. “What is that going to mean on our limited physician days?”
If St. Louis’ Planned Parenthood clinic is unable to offer abortions, the group said, Missouri would be the only state in the country to not have an operating abortion clinic. Five other states – Kentucky, Mississippi, North Dakota, South Dakota and West Virginia – reportedly have only one abortion clinic. And 90% of U.S. counties didn’t have an abortion clinic as of 2014, according to the Guttmacher Institute, a reproductive rights research and advocacy group.
For some, this echoes back to the days before abortion was legalized nationwide in 1973 with the Supreme Court’s Roe v. Wade decision, when patients who could afford to travel would go to more liberal states like California or New York where abortion was legal.
But providers in Kansas and Illinois say this influx from Missouri isn’t new. About half of their clients already come from the Show Me State. To the south, in neighboring Arkansas, where a 72-hour waiting period will go into effect in July, the vast majority of its patients still live within the state.
Over the past 10 years, four Missouri abortion clinics have closed because of increased regulations, including a mandatory 72-hour waiting period after receiving counseling on abortion, thus requiring two trips to a facility; requirements that physicians have hospital admitting privileges within 15 minutes of their clinics; and a rule requiring two-parent notification for minors and one-parent notarized consent. All those limits left one clinic in downtown St. Louis to serve the whole state.
Now Planned Parenthood, which operates that final abortion clinic, said on May 28 that it will be forced to end its abortion services altogether by May 31 if the state suspends its license. The closure is not related to new anti-abortion laws that Missouri Gov. Mike Parson, a Republican, signed on May 24 to ban most abortions after 8 weeks of pregnancy. The new laws don’t take effect until August.
Already the number of patients in Missouri seeking an abortion at the clinic from April 2018 until this April had dropped by 50% compared with the same period the previous year. Planned Parenthood spokesman Jesse Lawder attributes two-thirds of the decrease to the clinic’s refusal to do pelvic exams for abortions performed through medication – recently required by the state – thus forcing all such abortions to be performed out of state.
For Dreith, while she expects the Missouri numbers to continue to grow at her Illinois clinic across the Mississippi River, it’s not the only state sending patients her way.
“Patients were literally coming to us from the last remaining clinics in Kentucky ... so that they wouldn’t get past 24 weeks,” Dreith said. “We don’t want these patients in surrounding states traveling [to] New York [or] California like they once had to.”
That’s how it was prior to the Roe v. Wade ruling, according to Mary Ziegler, a professor at Florida State University College of Law who is writing her third book on the history of the legal battle around abortion access. She anticipates the pattern of privilege will repeat itself.
“You would still expect women with resources to be able to travel as far as they needed,” she said. “And you would expect women without resources to not be able to travel. ... The more the court retreats from protecting abortion rights, the more stark those differences will become.”
For Dreith, the historical comparison to the pre-Roe era rings true, albeit with improved medical practices.
There are safer, easier, and more effective ways to perform abortions now than the “horror stories that we saw pre-Roe,” said Dreith. “But I think the travel will be one of the huge throwbacks and the scariest part will be the criminalization.”
States such as Missouri could feel pressure to start arresting women who perform their own abortions with pills at home or travel out of state, Ziegler said. But, she said, “punishing women isn’t something that’s thought to be very popular.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.